. Acromegaly . Fig. l.j —.Skiagraplj of the left haml of a tuhject of acromegaly (of patient of Fij. 2). ACKOMEUALY. 61 Tinusually far from eacli other (increase of the cartilaginouscovering (?) Schlesinger). It is important to notice, especially for a diagnosisin doubtful cases, that the hands are notwithstand-ing never deformed or disfigured, but merely enlarged.The substance of the soft parts is increased, and it is difficultto raise the skin of the dorsum into folds. The naturalinterphalangeal folds of the knuckles are especially wellmarked ( mains capitonnees, Pechadre), as are the lines

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. Acromegaly . Fig. l.j —.Skiagraplj of the left haml of a tuhject of acromegaly (of patient of Fij. 2). ACKOMEUALY. 61 Tinusually far from eacli other (increase of the cartilaginouscovering (?) Schlesinger). It is important to notice, especially for a diagnosisin doubtful cases, that the hands are notwithstand-ing never deformed or disfigured, but merely enlarged.The substance of the soft parts is increased, and it is difficultto raise the skin of the dorsum into folds. The naturalinterphalangeal folds of the knuckles are especially wellmarked ( mains capitonnees, Pechadre), as are the lines inthe hoUoyr of the hand. The fingers are, as a whole, cylin-. FiG. 16.—The two types of hand in aoron:egaly. drical, and flattened from dorsum to palm. Since their circum-ference at the base and end is proportionately increased, thecomparison to little sausages (Marie) is justifiable. The nailsdo not share in the enlargement, they rather appear small, often flat, and frequently show slight longitudinal cracks. The bones of the hand are not aflEected to the same degreein all cases. Generally, as seen in the skiagraph (Fig. 15), the phalanges are somewhat coarser, with more markedlateral curves. Osteophytes, as already mentioned at p. 29, are not generally well marked. They may be even almostentirely absent; Boltz (2) found in his case, on post mortemexamination, a tiny exostosis on only one single phalanx. 62 ACROMEGALY. Our picture shows siich a one very plainly on the metacarpalhone of the index finger. In some cases the bones of the fingers show a decidedincrease of growth in length, through participation of theepiphysis, so that the hand becom